Treatment (Tx) patterns in patients (pts) with lung cancer starting 1st or 2nd generation (1G/2G) EGFR-TKI: a US insurance claims database analysis

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Anticancer Agents
Bioethics, Legal, and Economic Issues
Personalised/Precision Medicine
Thoracic Malignancies
Presenter Jhanelle Gray
Citation Annals of Oncology (2018) 29 (suppl_9): ix150-ix169. 10.1093/annonc/mdy425
Authors J.E. Gray1, B. Thakrar2, P. Sun3, S. Maclachlan4, N. Chehab5, D. Potter6
  • 1Department Of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, 33612 - Tampa/US
  • 2Oncology Business Unit, Epidemiology, AstraZeneca, CB2 1PG - Cambridge/GB
  • 3Oncology Business Unit, Epidemiology, AstraZeneca, Cambridge/GB
  • 4Analyst, Evidera, London/GB
  • 5Oncology Business Unit, Medical, AstraZeneca, 20878 - Gaithersburg/US
  • 6Oncology Business Unit, Medical, AstraZeneca, Gaithersburg/US



Approximately 50% of pts with EGFR mutated (EGFRm) NSCLC who progress on first-line (1L) Tx with 1G/2G EGFR-TKIs harbor the EGFR T790M mutation and are eligible for osimertinib, a 3G EGFR-TKI (first US approval in 2015). Pts with undetectable T790M typically receive chemotherapy. Presently, the Tx pattern following disease progression on 1L EGFR-TKI is poorly characterized. Using a US claims database, we describe 2L Tx in pts following 1L 1G/2G EGFR-TKIs, stratified by starting year of 1L Tx.


This is a retrospective observational study from the US Truven MarketScan Databases. Data included inpatient and outpatient insurance claims for diagnoses, Txs, and procedures. We studied a cohort of pts first diagnosed with lung cancer 2013–2017: ≥18 yrs, received 1L erlotinib, gefitinib or afatinib, ≥6 mths baseline data, no systemic therapies or lung surgeries for curative intent prior to TKI. Patients were followed from diagnosis and censored at end of enrolment or Sep 30, 2017.


We identified 1104 pts: median age 65 yrs (range 25–94); 64% female; uniform US distribution; 21% high Charlson Comorbidity Index (≥5); 78% metastatic disease; 31% brain metastases. Prior to 1L EGFR-TKI Tx, 62% had a biopsy and 37% had an EGFR testing claim (72% either biopsy or EGFR test). 1L Tx included erlotinib (86%), afatinib (13%) and gefitinib (1%). At time of analysis, 649/1104 (59%) pts were deemed still on 1L EGFR-TKI. 455/1104 (41%) pts were deemed off 1L EGFR-TKI: 281/455 (62%) with a 2L Tx claim (Table); 174/455 (38%) no 2L Tx claim and no 1L prescription >90 days of censor date.Table: 509P

2L Tx claim patterns in patients following 1L 1G/2G EGFR-TKI

n (%)All patients (n = 455)Patient started 1L EGFR-TKI before 2015 (n = 245)Patient started 1L EGFR-TKI 2015 or later (n = 210)
2L Tx claim281 (62)139 (57)142 (68)
Chemotherapy110 (24)69 (28)41 (20)
Osimertinib105 (23)28 (11)77 (37)
Afatinib61 (13)40 (16)21 (10)
Nivolumab3 (1)2 (1)1 (<1)
Crizotinib2 (<1)02 (1)
Presumed no 2L Tx*174 (38)106 (43)68 (32)

No 2L Tx claim and last 1L Tx prescription >90 days of censor date (deemed off 1L Tx).


With 62% of pts receiving 2L Tx after 1L EGFR-TKI, the study is consistent with emerging evidence indicating that not all patients are able to receive 2L Tx during follow-up after 1L 1G/2G EGFR-TKI. This study thus supports the importance of using the most effective EGFR-TKI as initial therapy, rather than reserving it as a 2L option, when it may reach fewer patients.

Editorial acknowledgement

Tom Hudson.

Clinical trial identification


Legal entity responsible for the study





J.E. Gray: Research Funding AstraZeneca, BI, Genentech; Advisor:AstraZeneca. B. Thakrar: Employee: AstraZeneca. S. Maclachlan: Employee: Evidera who provided analytical support to AstraZeneca for this project. N. Chehab: Employee, stocks: AstraZeneca. D. Potter: Employee, stock: AstraZeneca. All other authors have declared no conflicts of interest.